Short quick background... my daughter, now 17, was admitted to a child psych unit for one week in feb, 09 because of self injury. she was admitted again in oct. 09 because of severe depression. She was taken out of public school in Oct. 09 due to anxiety causing her to have to leave school daily and was homeschooled until Jan. '11 when she chose to reenter public school. . Since Oct. 09 she had been under the care of a psychiatrist who manages her meds. He recently diagnosed her with ADD and seems to now think that the undiagnosed ADD may have led to the anxiety and depression. When the anxiety issues reappeared after reentering public school, the doc. questioned her further and diagnosed the ADD.
I am concerned about the amount of meds. she is taking and while i plan on talking this over with the doc. on our next visit, i would really like the honest opinion of people who have had experience with any of this. She is also on meds. for GERD. She is a lot more focused since starting the vyvanse, but is also complaining about headaches more often than not. She also no longer wants to eat solid foods and went from drinking 2-3 20 oz. bottles of water a day, to 1/2 bottle. Her energy levels are extremly low and she seems just "spaced out" a lot which she refers to as feeling depressed. Here is a list of her current meds. :
I can identify with your daughter somewhat. Psych wards are no fun
Anyway, stimulants can indeed cause headaches. I get them sometimes when on my ADHD meds. I think her Vyvanse dose is TOO HIGH. 70mg is the max dose. Was she titrated up slowly, or did he just throw her on 70mg? If he threw her on that much straight away, it is time to find a new psychiatrist or see someone else for ADHD treatment. I have a high tolerance, but 70mg was too much for me. It made me sleepy, lethargic, tired, a little spacey, and just gave me an overall anxious feeling and gave me almost a feeling of dread. When I backed down to 60mg, I rarely get sleepy from it anymore and have less of the emotional side effects.
If she was titrated up properly and the lower dosages were not helping, perhaps it is time to try either dexedrine or adderall. There's also methylphenidate-based stuff like ritalin and concerta, but adults/older teens seem to find more relief with amphetamine-based stimulants. Ritalin lasts the shortest out of all ADHD meds to my knowledge. It didn't do a whole lot for me.
There's also the non-stimulant route like Strattera, but that usually is not a first choice, and with good reason. It doesn't work for most people, especially adults. It does seem to work well more in children, but even then, it's usually not a first choice. I had a hellish reaction - it changed me from a nice, polite, passive person to an incredibly angry (we're talking rage), physically violent, mean, rude person who was ****** at everything and everyone. And that's isn't even all it did to me. Never again!
If you have any questions about meds, feel free to ask. I'm pretty knowledgeable about ADHD meds. I like to know about what I take. Because of that, I also know about antipsychotics and mood stabilizers 'cause I take those too. But I, like your daughter, have GERD.
A little tip on the zantac...if she's having to take it twice a day, you might want to consider giving her omeprazole...it lasts 24hrs. You can buy it over the counter up to 20mg, though I take a 40mg prescription. Or you can save yourself some money and get a prescription for Ranitidine. It is the same thing as zantac, but you can get 60 150mg tablets for $4 at walmart - that's about the price of one small box of zantac. Well, that's a long enough post for now.
Last edited by Hoshi112; 03-14-2011 at 06:49 PM.
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Have you ever heard of the Feingold program? It sounds from your posts that all those meds are not really working satisfactorily in your daughter's case. The Feingold program is an elimination diet which can help with all the things your daughter is suffering from. I know that with teens you cannot control what she eats, but she might be willing to try something which may give her substantial relief. < edited >
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Hoshi, well said, you've clearly done your homework.
There's little I can add here beyond support for the above advice, but I'll throw in my two bits where I can. First, titration is definitely the correct way to begin taking any stimulant med (or any med for that matter). If your daughter was started out on 70mg Vyvanse, it's no wonder she's having negative side effects. Headaches can be a side effect of Vyvanse, and may indicate that she's on too high a dose, or that she started too fast (on the other hand, it may relate to dehydration as well, I'll come back to this). It's funny, when I had my own diagnosis and started treatment in 2008, titration was the norm, now it seems like doctors have forgotten it altogether. I'll also echo Hoshi's dislike of Strattera, I found that while it did help with self control to some degree, it led to extreme somnolence and nausea.
I have found that the effect of too much norepinephrine leads to somnolence, that 'spaced out' feeling, and general lethargy (this based on personal anecdotal evidence, not anything concretely scientific). This would likely be caused by too much Vyvanse, in addition to possibly the Klonipin, which is a medication that mimics norepinephrine in some ways. I'm curious about the Klonopin in the morning, I've generally seen it used in the evening to help combat rebound effects from the stimulant, as well as to help with sleep, due to it's calming effects (at least in relation to ADHD, for control of tics, morning may be appropriate).
As far as non-stimulant treatment of ADHD goes, I would personally recommend looking to Wellbutrin, rather than Strattera. Wellbutrin has been used for some time as a second line treatment for ADHD, and functions like an SSRI antidepressant, though working on different neurotransmitters. Wellbutrin acts by preventing the reuptake (breakdown and absorption) of dopamine and norepinephrine, which are the same neurotransmitters that stimulants act on, thus leading to similar effects as stimulants, but by a different road. It tends to be well tolerated, but may not be appropriate for someone with a history of seizures. Personally, I have found Wellbutrin to be a miracle drug, it's changed my life completely. Because it acts on the same neurotransmitters, it may or may not be appropriate to mix it with stimulant meds (in my case, I take both Wellbutrin and Adderall), this would be something to discuss with your phychiatrist.
My biggest concerns from your post, though, go more toward general health. How is your daughter's diet? Is she eating mostly processed foods, are her salt, sugar and/or meat intakes particularly high? The reason I ask is that GERD can sometimes be controlled by avoiding foods that cause an acidic response within the body, such as red meats, and foods high in carbohydrates. A diet high in fruits and vegetables, and very low in red meats, grains and processed foods may help control the GERD, and, as a bonus, such a diet is also correlated with improvement of ADHD symptoms. Sufficient water intake is also important, as dehydration is often accompanied by headaches (it stood out for me that your daughter started complaining of headaches when her water consumption dropped dramatically).
One more thing, never worry about the length of your posts, more information is always better than less. Besides, next to some of my marathon posts (which people somehow seem to wade though), your post was downright brief! We just hope we can help a little.
Best of luck!
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I just thought I'd add that fatigue and lethargy is a symptom of too much of a stimulant. I happened to be wading through the Adderall XR physicians prescribing sheet today looking for detailed information on it's mechanisms of action....which I was sorely disappointed to only find what I already knew, that it's a dopamine and norepinephrine reuptake inhibitor. Anyway, it mentioned symptoms of overdose.
But I have the personal experience of it, so I've been there. It makes you feel dead... I don't know how else to say it. You feel slowed down, tired, anxious. It seems a lot like depression.
As Thunor said, Wellbutrin may be something to look into. I take it. I found it does help with my ADHD symptoms, but not as much as Vyvanse, Adderall, or Dexedrine. They upside to Wellbutrin is that it is active 24/7....it doesn't wear off at the end of the day and you don't crash. You can indeed take stimulants while on Wellbutrin, but the stimulant dose may need to be adjusted, though not always. From everything I have heard and read, Wellbutrin helps SOME (not all), and only a bit. If it helps, it's enough to be noticeable, but you still have ADHD symptoms. I'm sure there are exceptions to this, but this is more of a general rule.
If the Celexa is not controlling her depression, it might be a good time to move onto another antidepressant. Wellbutrin is a SNRI, while Celexa is a SSRI. SNRI's seem to often be good for treatment-resistant depression. They effect norepinephrine along with serotonin and, as Thunor mentioned, dopamine - though only minimally. The very minimal effect on dopamine is probably why only small improvements in ADHD symptoms are usually seen on Wellbutrin.
Stimulants strongly effect dopamine. Amphetamines (I havent looked at methylphenidate mechanisms) like Vyvanse and Adderall cause the vesicles where dopamine is stored to release the dopamine, making the dopamine transport system works in reverse and expelling the dopamine into the synaptic cleft. Then it prevents reuptake. Cool, huh?
One thing I don't think I mentioned is the crash. Especially when you are taking too much, there's going to be a crash, which usually results in more fatigue and depression. Depression is very common when people "crash". So that only adds to the trouble.
Hey, just curious - is your daughter sleeping okay? Too little or too much? Sleep patterns are very important. Irregular sleep patterns can worsen symptoms, but it can also be signs of something else.
Because I have Bipolar disorder, I am hyperaware of these things. I'm trying not to jump at shadows and I'm certainly not implying I think she has Bipolar. It's just, with me, everything went to crap when I was put on an antidepressant. I was depressed before, but it was so much worse when I was put on the antidepressant.
Also, since the self-harm...has she been diagnosed with Borderline Personality Disorder? If so, or if she is suicidal, DBT therapy might be something to look into. It's similar to regular CBT therapy, but focuses more on skills that you can use to cope and change how you think. It's been shown to be effective for those who are suicidal or have borderline personality disorder.
I'd say something in her med cocktail isn't quite right if she's having problems without the Vyvanse as well. It can be SO hard to find the right medications!
I hope you actually come back and look at this thread....I hope I'm not talking to myself!
Once again, Hoshi had a lot of great things to say. I was concerned, though, upon reading her information on Wellbutrin, enough that I went scurrying back to my sources to confirm that I wasn't misinformed.
I'll do my best not to belabour things, but the information that I've read on Wellbutrin (again, it's one I take myself) is as follows:
Bupropion (Wellbutrin, Zyban and others) is classified as an NDRI antidepressant medication. Essentially, NDRI means Norepinephrine-Dopamine Reuptake Inhibitor. It has been shown in clinical studies (it's been on the market since 1989, and due to its novel nature, has been studied extensively) to increase available levels of dopamine and norepinephrine, being slightly more effective in relation to dopamine. Unlike other antidepressants of the reuptake inhibition class, it has negligible effect on seratonin.
There are several SNRI (seratonin-norepinephrine reuptake inhibitor) medications available on the market, such as Effexor and Cymbalta, but as Hoshi pointed out, they do little to affect dopamine levels, thus being of limited use with ADHD.
While treatment of ADHD with Wellbutrin is off-label, and generally considered second line (stimulants usually do the trick on their own), it has been shown in several studies, both alone and in conjunction with stimulant therapy, to produce positive effect in stimulant-resistant cases of ADHD, or in cases where stimulants may not be appropriate due to anxiety issues or abuse potential.
Last edited by Thunor; 03-15-2011 at 09:17 PM.
Reason: Accidentally hit 'submit reply' during the proof-reading stage. ;p
Hah! You got me. I thought it was a NDRI too, but when I googled it I came up with something that said it was a SNRI....I was like, okay, whatever, SNRI it is.
Maybe it's serotonin it only effects mildly. I can't remember. Well, one of the neurotransmitters.... It's been a while since I've studied about wellbutrin. Keep in mind, though, I wrote that after I had recently finished with a 4 hours stats test...my brain was dead. Excuses, excuses....